Provider Demographics
NPI:1508537895
Name:BENSON, KATHRYN BROWN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:BROWN
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADAC II, NCAC II
Mailing Address - Street 1:45A RUTLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-2042
Mailing Address - Country:US
Mailing Address - Phone:615-476-2931
Mailing Address - Fax:615-902-0465
Practice Address - Street 1:45A RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2042
Practice Address - Country:US
Practice Address - Phone:615-476-2931
Practice Address - Fax:615-902-0465
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0138101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0138OtherLADAC II